Lessons from down under – Australia’s climbing HIV rate

Recently reported stats show the level of new cases of HIV in Australia have jumped up 8 % from last year’s figure to 1137 (http://tinyurl.com/9crzoxr).This has been on the top of a steadily rising rate of new infections over the last ten years accumulating to a total increase of 50% over the last decade. The assumption amongst some sexual health organisations was that Australia had reached a plateau at the turn of the century (as in the UK and other countries), but these figures show this hasn’t been the case and that, actually, new cases of HIV far outstrip what can be accounted for by population increase over that time.

What’s gone wrong?

Certain elements of Australia’s HIV prevention work have been undeniably successful. The drive to ensure gay/bi men get tested, for example, has resulted in a high annual testing rate of around 60% (see http://tinyurl.com/9crzoxr).This is certainly enviable for most counties, and implies that testing frequency doesn’t explain the rise in new HIV cases. What are the reasons then and how can this spike in HIV cases be explained? It might be helpful to compare the Australian approach to the New Zealand one to answer the question. Whilst Australia has increasingly focused on drug-based HIV prevention strategies and taking PEP (for info on PEP see http://www.pep.chapsonline.org.uk/pep_basics.htm) after exposure to the HIV virus, New Zealand’s HIV prevention work, in contrast, has broadly remained focused on the condom use and lube.

New Zealand HIV prevention poster

The implication in comments by Shaun Robinson, the director of the NZ Aids foundation, is that the shift away from focusing on condom use has resulted in lower levels of condom use, even in spite of higher testing rates (http://tvnz.co.nz/national-news/nz-hiv-rates-plunge-australian-rise-5140707). Another possible explanation is that the move towards drug-based prevention has led to an emphasis on HIV as a manageable illness and shifted the meaning of the disease to one that is less dangerous. HIV is no longer seen as life-threatening and this seems to have led to complacency in relation to the infection generally and condom use more specifically. Whatever the reason, one thing is certain, the number of new HIV cases in New Zealand is moving in the opposite direction to Australia, with a year-on-year reduction of 33%. One positive effect of what are on the surface alarming statistics is that they appear to have been a wake up call for Australia and impacted it’s decision to sign up to a UN proposal to reduce HIV rates by 50% by 2015 (http://theconversation.edu.au/australia-sees-spike-in-hiv-infection-rate-10172).

Lessons to be learned

For the UK and elsewhere the Australian example emphasises the importance of carefully balanced HIV prevention work promoting HIV as both manageable and, to a certain extent, controllable, whilst also avoiding complacency and promoting condom use. It’s clear that whilst new rates of HIV have been moving downwards in the UK, in contrast to Australia, (decreasing from approximately 8,000 to 5,500 in the last 5/6 years) this must not be taken for granted and it’s certainly possible that if this balance isn’t right the number of new cases could start to rise again (http://www.avert.org/uk-statistics.htm).